Change Request Detail
No.
1178
Date
9/28/2012
Submitter
Type of Request
Pertaining to more than one, or not sure
Status
DSMO Process Completed
Business Reason
Contract Type code value request for Encounters reporting (Post-adjudicated claims)

Transactions:
837 Professional and Dental - 2300/CN101, 2400/CN101
837 Institutional - 2300/CN101

Requesting the use of code value 'FR' (Firm Fixed Price) which is listed in the 837 Standard Workbook for data element CN101, but not in the X12 TR3.  Otherwise, the creation of a new code value is needed.

The available values found in the X12 TR3 does not correspond to how majority of our providers are reimbursed.  For many providers and outpatient hospital services, the reimbursement is on a fee-for-service fee schedule basis that is derived from relative value units and not based on DRG, per diems, flat rates or percentages.

Current CN101 Contract Type values per the X12 TR3:
01                 DRG
02                 Per Diem
03                 Variable Per Diem
04                 Flat
05                 Capitated
06                 Percent
09                 Other
Suggestion
Encounters reporting would be able to utilize the data in the Contract Information CN1 segment.  An additional code would identify the reimbursement arrangement more appropriately.
DSMO Category
C
Recommendation
Approve. X12 will define the technical solution for inclusion in a future version of the Post-adjudicated data reporting 837 guide.
Appeal Recommendation